AB0197 PARASYMPATHETIC ACTIVITY IS NEGATIVELY ASSOCIATED WITH DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS – RESULTS OF AN EXPLORATORY PROSPECTIVE STUDY
Authors: J. Mucke, K. Schippert, M. Sluszniak, C. Reuter, D. Vossen, M. Schneider, G. Pongratz
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatoid Arthritis (RA) is often associated with autonomic dysfunction, which is presumably playing a role in the pathogenesis of the disease and may contribute to disease activity [1,2]. Accordingly, patients with RA show reduced heart rate variability (HRV) [3]. <h3>Objectives</h3> The aim of this prospective pilot study was to examine a possible connection between disease activity and activity of the autonomic nerve system in patients with RA. <h3>Methods</h3> In the non-randomized prospective exploratory study, patients with active RA and an upcoming change in treatment were included. Assessments were performed at baseline before treatment initiation (T0) and after 3 months (T1), including the Disease Activity Score 28 (DAS28-CRP), HRV measurement, and the physician and patient global assessment (PGA, PtGA). HRV was measured through a 5-minute ECG with finger electrodes, using Kardia App®. Total variability was measured by the variance of RR intervals over the temporal segment (Total Power) as well as by standard deviation of the average RR intervals (SDRR). Root Mean Square of successive differences (RMSSD) and percentage of number of pairs of adjacent RR intervals differing by more than 50 milliseconds (pRR50) were used for estimating parasympathetic activity. In addition, blood concentrations of Neuropeptide Y (NPY), vasoactive intestinal peptide (VIP) were measured as surrogate parameters for activity of the sympathetic (NPY) and parasympathetic (VIP) nervous system. Statistical analysis was performed using linear regression analysis. <h3>Results</h3> A total of 40 patients was included. Our results showed an overall improvement in both disease activity measured by DAS28-CRP (p= &lt;0,001; SMD= 1.393) and HRV (Total Power p= 0.014; SDRR p= 0.0023) between visits (Table 1). DAS28-CRP was inversely associated with parasympathetic activity (pRR50, p= 0.0494). PtGA also correlated inversely with pRR50 (p= 0.0049). RMSSD as another parasympathetic indicator was negatively predictive for percentage change of PGA (p= 0.0109). Patients with lower parasympathetic activity at baseline had a higher change in disease activity than patients with higher parasympathetic activity at baseline. <h3>Conclusion</h3> The results of our prospective study underline the importance of the autonomic nerve system regarding disease activity and prognosis in RA. Higher parasympathetic activity was associated with lower disease activity. Patients with initially lower parasympathetic profile and higher disease activity benefited to a greater extend from initiation or change of therapy. In our study, the specific blood parameters NPY and VIP showed no relevant association with disease activity and treatment response. <h3>References</h3> [1]Altawil R, Kadetoff D, Westman M, et al. A proposed mechanism for autonomic dysfunction in rheumatoid arthritis – reduced vagal activity related to high intrathecal IL-1β levels. Ann Rheum Dis 2012; 71: A7.1-A7. [2]Koopman FA, Tang MW, Vermeij J, et al. Autonomic Dysfunction Precedes Development of Rheumatoid Arthritis: A Prospective Cohort Study. EBioMedicine 2016; 6: 231–237. [3]Evrengül H, Dursunoglu D, Cobankara V, et al. Heart rate variability in patients with rheumatoid arthritis. Rheumatol Int 2004; 24: 198–202. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.